Online Form | University of Tennessee Student Health Insurance

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Campus Location

Chattanooga Knoxville Martin Tullahoma Southern Nashville College of Social Work

Student Status

Undergraduate/Graduate Students Student Enrolling in Dental or Vision Only International Students Enrolling Dependents Only UTK Appointed Graduate Students Enrolling Dependents Only

Choose Coverage Dates

Spring/Summer Coverage Covers January 1st, 2025 through July 31st, 2025 Summer Coverage Covers May 1st, 2025 through July 31st, 2025

Student Information

Last Name:

First Name:

M.I.

Gender:

Male Female

Date of Birth:

Mailing Address:

City:

State:

Zip:

Telephone Number:

Enter your student ID here:

I do not have a Social Security Number

Social Security Number:

Enter your Tax ID here:

Email Address:

Instructions on printing your insurance ID card will be emailed to this address.

Spouse and Dependents

Are you adding a spouse to your insurance plan?

Yes No

Are you adding dependents to your insurance plan?

Yes No

Relationship	Gender	Social Security Number	Last Name	First Name	Middle Initial	Date of Birth
Spouse	Male Female
Child 1	Male Female
Child 2	Male Female
Child 3	Male Female
Child 4	Male Female

Continue

Premium Selection

A brief summary of the coverage and services offered are:

Unlimited Maximum Benefit for Covered Expenses
Coverage available for eligible Dependents
$500 Deductible for Preferred Providers per Insured Person, per Policy Year
Covered Medical Expenses for Preferred Providers are payable at 80% after deductible
$25 In-Network Physician Visit Copay
$20 Tier 1 Copay / 30% Member Coinsurance Tiers 2-3 Prescription Drug Benefit
For more details, click here.

Payment is due in full at the time of enrollment. Optional Dental or Vision Coverage is available ONLY until the enrollment deadline of September 20th of each plan year and must be purchased on an annual basis. It is the student’s responsibility for timely renewal payments whether or not a renewal notice is received.

SELECTED COVERAGE PERIOD: Spring/Summer Coverage , 1/1/2025 -7/31/2025

To change your coverage period go back to the previous page.

Student, $1,708.00 Spouse, $1,708.00 Child, $1,708.00 Children, $3,416.00

What is a premium?

An insurance premium (sometimes referred to as the rate) is the amount of money you are charged for active coverage.

What is a deductible?

A deductible is the amount you pay before the insurance carrier will cover any remaining eligible expenses.

What is a copay?

A copay is a set portion of a total bill you are required to pay. This often refers to a physician office visit where the copay is your responsibility.

Learn More

Premium Selection

A brief summary of the coverage and services offered are:

Unlimited Maximum Benefit for Covered Expenses
Coverage available for eligible Dependents
$500 Deductible for Preferred Providers per Insured Person, per Policy Year
Covered Medical Expenses for Preferred Providers are payable at 80% after deductible
$25 In-Network Physician Visit Copay
$20 Tier 1 Copay / 30% Member Coinsurance Tiers 2-3 Prescription Drug Benefit
For more details, click here.

SELECTED COVERAGE PERIOD: Summer Coverage , 5/1/2025 -7/31/2025

To change your coverage period go back to the previous page.

Student, $732.00 Spouse, $732.00 Child, $732.00 Children, $1,464.00

What is a premium?

An insurance premium (sometimes referred to as the rate) is the amount of money you are charged for active coverage.

What is a deductible?

A deductible is the amount you pay before the insurance carrier will cover any remaining eligible expenses.

What is a copay?

A copay is a set portion of a total bill you are required to pay. This often refers to a physician office visit where the copay is your responsibility.

Learn More

Back Continue

Selected Premium Total

Subtotal: REQUIRES JAVASCRIPT

Payment Information

First Name

Last Name

Mailing Address:

City:

State:

Zip:

Premium total includes a 2.5% processing fee.

Visa / Mastercard / Discover Cards Accepted Only

Card Number: CID Code*

*CID code is the last, 3-digit number printed on the signature strip on the back of your card

Expiration Date:

Surcharge: REQUIRES JAVASCRIPT

Total Charge: REQUIRES JAVASCRIPT

Your card will not be charged until you click submit.

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